Provider Demographics
NPI:1073500229
Name:LAPHAM, DIANE F (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:F
Last Name:LAPHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 LPGA BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-7118
Mailing Address - Country:US
Mailing Address - Phone:386-274-1744
Mailing Address - Fax:386-274-1644
Practice Address - Street 1:1980 LPGA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-7118
Practice Address - Country:US
Practice Address - Phone:386-274-1744
Practice Address - Fax:386-274-1644
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37519207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64483Medicare ID - Type Unspecified
FLD57698Medicare UPIN